Tubal Reversal(Reversal of Sterilization)

Tubal reversal, or tubal reanastomosis is a safe and effective operation which has been performed successfully for more than 20 years. There are many ways to perform this operation, but it is essential that an experienced physician, who is trained in the use of microsurgical instruments and techniques, perform this delicate operation. We believe the best way to perform this operation is with the use of an operative microscope and the use of sutures that are extremely fine and commonly used in eye surgery. The openings of the tubes which must be reconnected are typically very small, and failure to properly align the segments, even by as little as one millimeter, can make the difference between a successful and an unsuccessful operation.

We typically perform this procedure on an outpatient basis, using a small 6 cm bikini-type incision. We do not prefer to perform the procedure laparoscopically, although this could be considered under special circumstances. The operation typically takes 2.5 to 3 hours. Numbing medicine is injected into each tissue layer after the operation so that the patient is comfortable enough to leave the Surgery Center several hours after the operation. Recovery time is shorter because of the small incision size, but your ability to return to normal activities or work will vary.

Patients that are significantly overweight may not be able to have their operation performed on an outpatient basis. We do not operate on patients over 300 pounds or with a BMI (Body Mass Index) over 40. The reason for this is that the abdominal wall may be too thick to utilize the very small incision, so a larger incision must be made, and this may require an overnight hospital stay. This determination must be made at the time of the initial exam. The procedure is just as safe and successful when performed through a standard, larger incision. Exceptions to this post-operative hospitalization have been made if around-the-clock nursing care is available to the patient for 24 hours. Unfortunately, there is no way to determine the likelihood of being able to perform the operation through a small incision as an outpatient without performing a physical exam.

You should also be aware that, in rare cases, too much of the tube may have been removed to perform this operation, or that severe scar tissue or other abnormalities could prevent the successful performance of this operation. Of course, this is not known until the time of the operation.

Factors Which Influence Success Rates

The success rate of the operation, defined as the ability to conceive intrauterine pregnancy, approaches 80%.

The type of tubal ligation can influence the success rate of the procedure, however, most types of sterilizations can be reversed. This includes burning, cutting, tying, banding, and clipping. The amount of tube which has been removed or destroyed may also influence the success rates, since at least 4 cm of tube are needed to achieve optimal pregnancy rates. However, we have seen pregnancies in women with tubes as short as 2 cm. Time since the tubal ligation was performed may play a minor role, but we have seen successful pregnancies even in patients who have had their tubes tied for 15 to 20 years. The age of the patient is also significant. We have had successful pregnancies in women well over the age of 40, but fertility generally decreases at age 40, and expectation for pregnancy must be appropriately adjusted. Finally, any concurrent infertility factors, such as absent or infrequent ovulation or low sperm counts could lower the chance of a successful pregnancy after this operation.

Risks

Tubal reversal is one of the safest gynecologic operations. We have never had a serious post-operative complication following this surgery. There is a risk of tubal (ectopic) pregnancy following this or any tubal operation. Therefore, it is necessary to perform a very early evaluation to rule out tubal pregnancy in a woman who has undergone reversal of sterilization. Other risks will be discussed at the time of your visit.

Pre-operative Testing

It is helpful to have a copy of the operative note from the tubal ligation operation as well as a pathology report on the tubal segments which were removed, if applicable. To rule out significant problems with the sperm, a semen analysis on the husband is also recommended. A hysterosalpingogram (HSG), or X-ray of the uterus and attached tubal segments, is usually performed as well. Those traveling from outside the area can have these procedures performed by their local physician and bring them at the time of their initial visit.

Financial Considerations

Surgery for reversal of sterilization is covered by some, but not most insurance policies. Outpatient fees for this operation are $2,900 for the hospital fee, $700 for anesthesia, and $2,400 for surgeon's fees (A total of $6,000). If inpatient hospitalization is necessary, the total charges will be higher and dependent upon the length of stay in the hospital. This includes fees to the Surgery Center, anesthesia, and surgeon's fees. In order to schedule surgery, a non-refundable $400 deposit must be paid in advance. The remainder is due the day prior to surgery (money order, cashier's check, Visa, MasterCard or Discover). Anesthesia and Surgery Center fees may also be required in advance. A discount of $400 from the surgeon's fee is given if a patient refers one other patient for this operation and the operations are performed on the same day. Patients with a BMI of 32 or higher may be required to pay an additional fee of $900, and may be required to stay overnight in the hospital, subject to the results of the physical examination . We do not operate on patients over 300 pounds or with a BMI (Body Mass Index) over 45. Patients with a BMI of 40-45 may or may not be candidates and must be evaluated by Dr. Keenan to determine this in advance of surgery scheduling. This visit would incur a routine office visit charge.

Is Tubal Reversal the Only Option?

No. In Vitro Fertilization is usually an option as well. However, tubal reversal generally carries a somewhat higher pregnancy rate at a slightly lower cost, and therefore is a better option for most couples. Couples with a history of very low sperm counts, significant pelvic scarring or infection, or other problems may be better served by In Vitro Fertilization. The Southeastern Fertility Center has one of the nation's finest programs in IVF and Assisted Reproductive Technologies. Please see the corresponding web page, or call our office for additional information.

Information for Travelers

Those patients traveling from outside the East Tennessee region may want to fly into Knoxville's McGhee-Tyson airport. The Tri-Cities airport and Chattanooga airports are each approximately a 90-minute drive. Nashville International Airport is a 2 1/2 hour drive.

We require you to be seen in the office the day prior to surgery, and you must stay in town the night following the operation. Located approximately 10 minutes from the Southeastern Fertility Center, the Hampton Inn is convenient to the Surgery Center.

Additional Information

A physician referral is not required for an appointment. Our policy is to treat only married couples. For even more detailed information including photos of the procedure itself, please see our dedicated Tubal Reversal Website at www.BestReversal.com.

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Legal Disclaimer: The information contained on this site is for informational purposes only, and should not be construed as medical advice or be substituted for the medical advice of a physician. You should consult a qualified physician about all matters pertaining to your health.